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  • [Radiother Oncol .] Definitive chemoradiotherapy versus esophagectomy in patients with clinical T1bN0M0 esophageal squamous cell carcinoma: A retrospective study

    [Radiother Oncol .] Definitive chemoradiotherapy versus esophagectomy in patients with clinical T1bN0M0 esophageal squamous cell carcinoma: A retrospective study

    울산의대 / 조윤영, 김종훈*

  • 출처
    Radiother Oncol .
  • 등재일
    2021 Sep
  • 저널이슈번호
    162:112-118. doi: 10.1016/j.radonc.2021.07.006. Epub 2021 Jul 13.
  • 내용

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    Abstract
    Background and purpose: This study aimed to determine the equivalence between definitive chemoradiotherapy (DCRT) and radical esophagectomy in clinical T1bN0M0 esophageal squamous cell carcinoma (ESCC).

    Materials and methods: Among 282 patients with cT1bN0M0 ESCC, 238 underwent radical esophagectomy and 44 underwent DCRT. Both treatments were retrospectively compared overall survival (OS), progression-free survival (PFS), and complications.

    Results: The DCRT group exhibited poorer patient characteristics than the surgery group, especially with mean age (73 vs. 63 years), Eastern Cooperative Oncology Group (ECOG) status, and Charlson Comorbidity Index (p < 0.001, each). The median follow-up duration was 49.5 (range, 0.4-97.0) and 45.5 months (range, 5.0-112.0) in the surgery and DCRT groups, respectively. In the DCRT group, clinical complete response was achieved in 43 patients (97.7%) at 1 month after treatment. The 5-year OS rates were 75.8% and 68.8% (p = 0.135) and the 5-year PFS were 63.8% and 57.8% (p = 0.637) for the surgery and DCRT groups, respectively. Local recurrence rates were identical between the two groups (11.4% and 11.4%), but the distant metastasis rate was lower in the DCRT group (n = 1, 2.27% vs. n = 29, 12.15%). Grade 3-4 hematologic toxicities were observed in 11 patients (25%) of the DCRT group, and 56 patients (23.5%) in the surgery group showed grade 3-5 surgical complications, including mortality (n = 5).

    Conclusion: Based on the non-inferior survival rates, recurrence patterns, and complication rates without critical surgical mortality, DCRT was comparable to esophagectomy for cT1bN0 esophageal squamous cell carcinoma.

     

     

       

     

     

    Affiliations

    Yoon Young Jo 1, Jesang Yu 1, Kye Jin Song 1, Jeong Yun Jang 1, Ye Jin Yoo 1, Sung-Bae Kim 2, Sook Ryun Park 2, Yong-Hee Kim 3, Hyeong Ryul Kim 3, Jong Hoon Kim 4
    1Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
    2Department of Medical Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
    3Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
    4Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address: jhkim2@amc.seoul.kr.

     

  • 키워드
    Comorbidity; Definitive chemoradiotherapy (DCRT); Esophageal squamous cell carcinoma (ESCC); Radical esophagectomy; cT1bN0M0.
  • 연구소개
    임상병기 cT1bN0M0인 초기식도암의 전통적인 치료는 수술이었으나, 수술을 거부하거나 수술을 시행할수 없는 환자들에서 항암방사선치료를 시행하여 수술과 대등한 5년-생존율, 무병생존율, 국소완치율을 얻을 수 있음을 확인한 연구입니다. 그런 결과가 가능했던 것은 진단기술 및 항암방사선치료의 발달로 인해 정확한 진단을 바탕으로 큰 합병증이나 후유증 없이 안전하면서도 높은 완치율을 기대할수 있게 된 것이 가장 중요한 이유입니다. 특히 항암방사선치료를 받은 환자군이 연령대도 높고, ECOG status 및 동반된 질환들이 많음에도 불구하고 대등한 종양학적 결과를 보였다는 것은 향후 점차 늘어나는 초기식도암의 치료 방향에도 변화를 줄수 있을 것으로 기대됩니다.
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